Urethritis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2], Cafer Zorkun, M.D., Ph.D. [3], Sujit Routray, M.D. [4]

Overview

Once the diagnosis is confirmed, the appropriate antibiotic regimen should be initiated to reduce the risk of complications. The standard of choice is described below.

Medical Therapy

Antibiotic Therapy

Disease	Treatment
Non-gonococcal Urethritis	Preferred: Azithromycin 1 g PO in a single dose OR Doxycycline 100 mg PO bid for 7 days Alternatives: Erythromycin base 500 mg PO qid for 7 days Erythromycin ethylsuccinate 800 mg PO qid for 7 days Levofloxacin 500 mg PO qd for 7 days Ofloxacin 300 mg PO bid for 7 days
Gonococcal Urethritis	Preferred: Ceftriaxone 250 mg IM in a single dose PLUS Azithromycin 1 g PO in a single dose Alternative: Cefixime 400 mg PO in a single dose PLUS Azithromycin 1 g PO in a single dose
Recurrent and Persistent Urethritis	Metronidazole 2 g PO in a single dose or Tinidazole 2 g PO in a single dose PLUS Azithromycin 1 g PO in a single dose

Follow-Up

• Patients should be instructed to return for evaluation if symptoms persist or recur after completion of therapy.
• Symptoms alone, without documentation of signs or laboratory evidence of urethral inflammation, are not a sufficient basis for re-treatment.
• Providers should be alert to the possibility of chronic prostatitis/chronic pelvic pain syndrome in male patients experiencing persistent pain (perineal, penile, or pelvic), discomfort, irritating voiding symptoms, pain during or after ejaculation, or new-onset premature ejaculation lasting for >3 months.

Treatment of Sexual Partners

• All sex partners within the preceding 60 days should be referred for evaluation, testing, and empiric treatment with a drug regimen effective against chlamydia.
• A specific diagnosis might facilitate partner referral. Therefore, testing for gonorrhea and chlamydia is encouraged. A substantial proportion of female partners of males with non-chlamydial, non-gonococcal urethritis are infected with chlamydia.
• Partner treatment is recommended for males with non-gonococcal urethritis regardless of whether a specific etiology is identified.